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Home My WebLink About9308-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date ............. ~.. a..~.0.t9:., .2.2 ........... 19.8.3. THIS CERTIFIES that the building .. Agditi~n .................................... Location of Property . 90 · .Summit .Road ........... Sour&old.,..N, .Y. ................ House No. Street Hamlet County Tax Map No. 1000 Section ...7.8. ....... Block .... 9. .......... Lot .... 2.8.5.2.9. ....... Subdivision....B.~.~..8.i.d:e...~.o?.~.~..c? .......... Filed Map No..2.0.3.~...Lot No....275 ..2.~ .... conforms substantially to the Application for Building Permit heretofore Fried in this office dated ..... .J..m3e...'1.5. ...... 19 77. pursuant to which Building Permit No ..... 9,3087, ........... dated . .J..u_~..e..'1.5. ................. ~97.7. ,was xssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ......... .~.. ?~5.~.~5~.~., 5~. %z.~., .~.~., .~ .~. 4.%~.%?.= ........................... The certificate is issued to . .Aud.~..e7..% .~.d.w.a..~.ct..0.5:.e..Z.~.~.k. 9 ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....lXl/.4 ................................... UNDERWRITERS CERTIFICATE NO ........... .3I/.A. ................................... Building _Inspector Rev. 1/81 I~OEY/ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S~ OFFICE SOUTH'OLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9308 Z Permission is hereby granted to: ~0 .................................. : ..... ~ .................................................................................................................. at premises Iocc~fed at ~ ~ ~...~..~' ~tl~2q~ll~e ................... ....................................... ; ....... .~...~..~ ......... ~.x..a..~. ........................................... 19].J.~/...., and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of ail 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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of comptetPd site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. Co Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 , Date ..... , .. New E~ ........... Old or Pre-ex~sting Building(:~)~ ..... =/Vacant Land ............ Location of Property ..... .~.,~,' ......... ~.~;/_,J ~]'~)3 ~..~. ~~ ..... ~.~-/.~ ,~:~;: Owner or Owners of prH~rt~°'.. ~'~ ~.. ~/~S~..~.~,~., ~..Cj'.~.~ .... .... ..... .... ;... Subdivision..~.~d.~?~¢....,.~.~ ....... Filed MapNo. ~.~:.. .Lot No. ~.~t'.~... Perm,t No..~.~.~. Date of Permit ~~Appl,cant.. ~.~ ~ ..... ~;.~/~. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval ' ., . .~ Request for Temporary Certificate ..................... Final Certificate . X ..... - ......... ' Fee S, mitted $. .................. Construction on above described building and permit~ meets all appti,cable_,Codes and regu lat~ons. Rev, 10-10-78 Memorandum from.... BUILDING INSPEC'rORS OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 lq)EM NO. ! TOWN OF SOIJTHOLD BUJLIDING DEPARTMENT TOWN CLERK'S OFFICE Application No....~....~.....~..~ .... D~sapproved a/c ........... 7~. ~ ..................................................... APPLICATION FOR BUILDINGPERMIT '~/ Date ...... INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin[ 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 of property must be drawn on the diagram which ~s part of this application c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector w~ll issue a Building Permit to the applicant. Such permii 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 Bwlding 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. ature of applicant, or name, if a car ~oration) ~ (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........... ~~i.,' ...... Plumber's License No ................................................. Electrician's License No ............................................ Other Zrode's L~cense No ...............................................~.~'~/~/'~.--~---~'~ Location of land on~vh,ch p~:~posed work will bex~ne. Map No ~'~/~/---~""~' ~.~...~T~Lot No.."~'~z(./(. ............ Street and Numb~r~~~..~'Z.¢~.~. .............. ...~...~ ...................................... Municipality State existing use and occupancy of~d intended use and occupancy of proposed construction: a Ex,siting use a~nd occupancy ....................... ~!.~.'. ....... / ................................................................................... b Intended use and occupancy ................. .~). ......../-~..~,.....~..~ 3 Nature of work (check which apphcable). New Building ........ Addmon . ./.-rrff....... .....Alteration ......... Repair .............. Removal ................ Demoht~or .............. Other Work ................................. ~.. ~.~......~.. (Description) 4. Estimated Cost ............ /..~...~.. .............................Fee ~ .............................................. (to be pa~d on fihng th~s apphcabon) 5 If dwelling, number of dwelling umts ...................... Number of dwelhng umts on each floor .................. if garage, number of cars ......................................................................................................................... 6 if bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ................. 7 Dimensions of existing structures, ~f any. Front../.-<(. ................. Rear ................................Depth ..J.4~! ......... Height ........................ Number of Stories ................................................................................................... D~mens~ons of same structure with alterahons or addmons Front ...... ~,~../.. .................... Rear ........................ Depth .......... /..~... ............Height .................. Number of Stories ........................... 8 D,mens,ons of ent, re new construct,on' Front ...... ~---I ................... Rear .......................... Depth ...//.~¢~ Height .................. Number of Stones ...................... ' ........................................... 9 S,ze of lot Front ...... ~..//~. .................................. Rear .................................... Depth .... ./4¢~. ............... 10 Dote of Purchase ./...~..~.. ............................... Nome of Former Owner ..... x'.~.....a.../.~...¢~,- ............................. 11. Zone or use district in which premises are s~tuoted .................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: ..¢~..~ ............................................... 13 Will lot be regraded ..... ,Lb(..~:~..¢.¢ //~Will e~,cess fdl be removed from premis~,s~ ( ) Yes 14 Nome of Owner of prem,ses ...~.~¢¢~/.~/.'.'.'.'.'.'.'.'~..~ .... Addres ~.~_ .~ ..... Phone No./~.,.~..~.._ Name of Architect ............................. Address~ ................................ Phone No ....................... Nome of Contractor ................................. Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and red,cate all set-back dimensions from propcrty lines G~ve street and block number or description according to deed, and show street names and indicate whether interior or corner lot , ^l/Ch ;.S ............ ;~.~..¢~¢3...~~ ........................ be,rig duly sworn,' deposes and says that he ,s th'e opChcan (Ix)'Clle of individual s~gnmg contract) above named He is the ................ ~ ...... ..~.. ........ ~ ............................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to oerform or have performed the so~d work and to make and th~s apphcabon, that oll stoterr, e~ thor the work will be performed~ Sworn to bef. pre. e_me this ...............//'~.~.. day of .... Notary Pubhc, . .............. ._ ontamed ~n th~s application ere true to the best of his knowledge and belief, an~ ,manner set forth in the apphcahon filed therewith.