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Home My WebLink About9307-zFO~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTME, NT Town Clerk's Office Southold, N. Y. Certificete Of Occupnncy No.. Z7~72 .... Date .... Sep~;e~ber 6., .......... , 19.~?. THIS CERTIFIES that the building located at -9~* Conkl~ln. Rd., .l~at~;. · · Street Map No ............ Block No .......... Lot No ..... P3.ot. D. ..................... confoms substantially to the Application for Building Permit heretofore fried in this office dated .. ,,Tulle..$~, ......... , 1977.. pursuant to which Building Pea:mit No. 9~07Z.. dated ...J. ulle..$~ ......... , 197.~.., was issued, and conforms to all of the req,~;ire- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . A~eesaory. garage .~nd~ .s~;orag~ .build~-~ .......................... T[~e certificate is issued to ... ,T~es E .. R~cke.~ts ................................ (owner, ~t) o£ the aforesaid building. Suffolk County Department o~ Health Approval .... JN~ ......................... UNDERWRITERS CERTIFICATE No .......... N,/~I~ ............................... HOUSE NUMBER ,9~ ....... Street .... Co~:in. Road~. ~t~ft-'ackt.. o 1~, .Y, Buildiflg Inspector 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) 9307 Z Permission is hereby granted to: ........................ ~; ........... , ..... ~. ................ ~.~.T. ............................................................................. j ............. at premises located at pu~suont ~o appli~otion d~ted .... L ................. ..;.~.....~ .............. , ~9...~, and opp~oved b~ ~he Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fJl4ed 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, Industriel buildings, Mulhple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building, §. Submit Planning Board approvcfl 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 sh6wing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or pl~evJous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspechon 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 $5.00 3. Copy of certificate of occupancy $1.00 G ,~1..,~.~ C~ ~.. Date ..... .-;~..~T~..~4. · '/...~....~.... :../... / New Building ...... ~ ........... Old'or Pre-existing Bu~dding ............................ Vacant L.and ............................ Location Of Property ..~..~.../~.....~.....~.~.~...~...~....~..4..~E~......~....~.~.~...~.~..~.~..C~ / Owner Or Owners Of Property ........... ..~....~..~EF~.~..~ ....... --~../..~Z~.~...~. .............................. Subdivision .......................................... .' ..................... Lot No ............. Block No ............. House No ............. Permit Date Of Permi;. . . .App'icant ....... Health Dept. Approval .......... ~..~..../...~.. ................... labor Dept. Approval ....... ..../~..,~.....~ ...................... Underwriters Approval ................./~..,~ ................... Planning Board Approval ...... .../~..../.~.. ...................... Request For Temporary Certificote ........................................ Final Certificate ........... ~ ................... Sworn to before me this .... day of ............. Notary Public ......... ..~.~.~/~.... County Fee Submitted $ .................................... Construction on above describe~t building and p r~, me~t ~11 applica~bl,~/c~ r,~gulotlons. A I t \/ pp ican.. .................. ....................... (stamp or seal, ,~/~ ~/,~ ~ !' NOTARY PUBLIC, State ol New Yo~ No 52.8125850, Suffolk ~'~'m £~p~res March 30. BUILDING DEPARTMENT . ~UTHOLD, N.Y. ~ ~ ~' ............ ....... ~proved ........................ ~.~ ...... ~.~:, 19 ...... ~ Permit No .................................... Disapproved a/c ...... ...~.......~........_.....~ ...................................................................... ............. ......................... ...................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This application must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Bull Inspector, with 3 sets of plans, accurate plat plan to scale. Fee according to schedule. b Plot plan showing location of lot end of buildings on premises, relationship to adjoining premises or public stree areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this apphca c The work covered by this application may not be commenced before issuance of Budding Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such p' shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occup. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant tc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmanc: RT~geulZpt~i~n[~argtrhe~sc?~nsctr~u~i~ynw~hb~d~t~c~t~n~r~tJrati~ns~ or fOan~n~ rjc~eO, V~lo~Jind;cmoOlitde~hgue[aeit~ondse, Sc~, / 5~5 Riverleigh Ave~t~e (Address of applicant) Riverheacl,Ne~v York 11901 State whether applicant ~s owner, lessee, agent, orchitect, engineer, general contractor, electrician, plumber or b~i Name of If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~..~..~. ........ ~,fl..O..U..,~.._hz....~..1.g.~,O.,.~...~OW~ ) Plumber's License Electrician's License No ............................................. Other Trade's License No ............................................... ~/~r~ ")-L~.~ 1~-"~' -.-~.~ ~, ~ Location of land on which proposed work will be done. Map No' .. ~..]q.8.zj:. ......................... Lot No.....&.~.....~....~ Street and Number .............. .N?~..~~ ............. ~...~.~.:L.~.'o...o..~.. ............................................ ~ ~~~ Linc;~ Municipality State existing use and occupancy of premises and m~.ended use and occupancy of proposed construchon: a Exisitmg use and occupancy ....... ,0..~.e.....~.~.i..,~.~.. ~.e..~..~.~.e..~...q.e. .................................................................. b. Intended use and occupancy ...... ..gr...~.,~g.~ ................................................................................................... 3, Nature of work (check which appllcc~b(~), New Building ....~ ........... Addition ................ Alteration .............. Repair .................. Removal ............... Demoht~on ................ Other Work ............................................... ., (Description) 4, Estimated Cost ....... ,~.,~000,..OO ......................... Fee ... zl..?...,~...~.---.,... .............................................................. (to be paid on filing this application) 5 If dwelling, number of dwelhng units ........................... Number of dwelling units on each floor ........................ If garage, number of cars .......... ~ ............................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ....................... 7 Dimensions of existing structures, if any' Front ..... ~'~ ................ Rear ....... ~,~ .................... Depth ...4~ ............ Hmght ......I~ ............... Number of Stories ........ ,1,. ~,.17~-. ............................................................................... D~menslons of some structure with alterations or additions: Front ....................................Rear ........................ Depth ................................ Height ......................... Number of Stories .............................. B Dimensions of entire new construction: Front ........ ~,0 ..................... Rear ........ ~0. .............. Depth ..... ~,~ ......... Height .......~ ......... Number of Stories .......... ,~.~. ;L/.~ ....................................................................... 9 Size of lot Front .............. ~ ................................. Rear ......... ~.~ ......................... Depth ...... ~,.Oc~ ............... 10. Date of Purchase .......................... ,~)~.~ .............Name of Former Owner .................................................... 11 Zone or use d~stnct in which premises are situated .............................................................................................. 12 Does proposed construchon violate any zoning law, ordinance or regulation' . ..... [~ ......................................... 13 Well lot be regraded ....... 2[~ ............. Well excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises .... ~'~.OI3...]~.~..~f-~.~.~ ..... Address ~.~.~...~..~..~.~.. Phone No ................... Name of Architect .......................................... Address....,...........................~t~'~'fSRO~ Phone No. Name of Contractor .J~O~:~,~. ~[. (~.O~ .................. Address~..;.¢.~...~;,'~,~.].?.~.'.~..~.LPhone NoY..~.,.~.~,.~, PLOT DIAGRAM Ave ,~Ve~hoP. t~, ~,~ Locate dearly and distinctly all buddings, whether existing ar proposed, and indicate all set-back d~si~hs fr property lines Gwe street and block number or description according to deed, and show street names, '~nd/ indic, whether interior or corner lot, I STATE OF NEW YJD~RK,,_,,- ~ ~ t c S cOUNTY ..,.- /~.~,~.c,~.. ..........~.. ........... .~,~.~ ....... being duly sworn, deposes and says that he ,s the Qp (NaMe of~nd~wdual sigmng controc~cf)) above named ,, ......................... ......................................................................................... (Contractor, agent, corporate officer, etc of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and t~e th~s application; that aH statements contmned in th~s applicat~on~ta the best of his knowle~ on,eli thor the work wdl be performed m the manner set fo~h in the ap~cation fi~therewith. Swam ~o before me Chis .......................... ~. . ~ ~1 ~ ' t~igna~ure or appli?~t) ~L~AB~ ANN N~ILL~ NOTARY PUBLIC, State of N~w No 52-8125850, SuffoJ~ Term Expires March 30, J