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Home My WebLink About9316-zNO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z9020 .... Date .. May .... q8 ............ , 19.?1~ THIS CERTIFIES that the building located at . 1/450 Bayvte,~ .Rd, ........ Street Map No. 113} .... Block No ........ Lot No .... lJ/~..-.~.~.7. ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated . .~Yurle . 20 , 19.7.? pursuant to which Building Permit No.. 9316Z. dated ~lu~e. · 20 ...... , 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 . . PRIVATE .01~. F. AHI. LY.. D..I~.,: .~...h~.TH..AI~...~.~.o.N .(.D..E~..K.). .......... The certificate is issued to ~g.en.e .&...F4.~h.e.a .co..h?.n. ....................... ( ow n er ,:l~:~ of the aforesaid building. Suffolk County Department of Health Approval .... N/.R .................... UNDERWRITERS CERTIFICATE No ...... -: ~.'. ' ......... N./R. ~ HOUSE NUMBER . ~./450 ... Street ...... Ba. yyi..e~...R.~.:__ ....... J ............... ....................................... . ~..~.o.~..~,..~.~. ~o..r.k. .............. Build'~fig Inspector FORI~ NO. 2 TO~N O~ $O~TSOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9316 Z Date .... Permission is hereby granted to: ~o ...:....:.~~ .... ~=,~ ~, .~__~.: /1 - ~ ~ ,,-_ :...~ Building In~or. // Fee $ ........ FORM NO. 8 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in 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, 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 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. 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 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 pet. ..... ...... New B~ilding ................ Addition ..!~...E~....~... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~.~...~..r.~...e..~....~..~.~..e./.'.~...'~.....~..~..P~.~. ..... ~...e~.......~...~...~.....~..~.......<~...O..~..~..~...~. ........... Owner Or Owners Of Property ....... Subdivis,on ........................ ~...~: ................................ Lot No ............. Block No ............. House No....J~...~. .... Permit No ........-..--. ........ Date Of Permit .................... A,oplicont ................................................................ Health Dept. Approval ........................................... ~or Dept. Approval ................................................ Underwriters Approvo, ...................... ......... P,annlng B rd App va, .......... ................. Request For Temporary Certificate ........................................ FinoJ Certificate ........... ~... .................. J Fee Submitted $ ................. ,~.. ............. Construction on above described building and permit meets all applicable codes and regulations. Applican ...... .............................................. 5worn to before me this ................ day of ............................................ Notary Public ................................... County (stamp or seal) .~-~ 8~ ,7~ ,~'c w- IW~ ~C- ~ 7__ ~o~ o TOWN OF SOUTHOILD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined '..~. c:~/ , Approve~ ........................................ 19...,-:.... Permit No...~...~./.,.~....t~ ........... Application No..,~,..~,,,,~.,.,,~.. ........... Disapproved a/c ' ~' (Building Inspector) APPLICATION FOR BUILDING PERMIT ,/~ Date ............... INSTRUCTIONS a. Th~s applicahon must be completely filled in by typewriter o¢ 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 location of lot and of buildings an 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 applicatio c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector wdl issue o Building Permit to the applicant. Such porn shall be kept on the premises available for inspection throughout the work. e No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan, shall have, been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to ti Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulahans, far the construction of buiJdings, 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 necessary inspections. (Sig_.nature of,applicant, or name, if a corporation) /('Address of applicant) ' ~,/ State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build¢ /- If apphcont is a corporate, signature oFduly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~. .......................... Plumber's License No. - Electrician's License No ............................................. , · II'~5''~ / Other Trades License No ............................................... ~ / .~'t . ' Location of I~nd on which proposed wor~ be done. ~p Ho..~ ............ ~~.'..; ....... ZZ..~ .... ................................... State existing use and occupancy of premis~ and iqtended use and~panc~f pr~ose~onst¢;~~al,~ ..... ................. b Intended use and occupancy ..;,~..~~~.~ .................. 3. Nature of work (check which applicable) New Bu~Id~ng ........ Addition.. Alteration ............. Repc~r .............. Removal ............ Demoht~or .......... Other Work ......................................... ~-/ (Description) 4 Estimated Cost .................... ~'C~..4:2 ..................... Fee/..~....z::;; ................................................................ (to be pad on fihng th~s application) 5 If dwelhng, number of dwelling umts ...................... 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 D~mens~ons of ex~st~ng structures, if any. Front ....................... Rear ................................ Depth .............. He~clht ........................ Number of Stones ..................................................................................................... D~mens~ons of same structure with alterations or addmons Front .................................. Rear .................... Depth ................................ Height ................ Number of Stones ....................... 8 D~mens~ons of enhre new construction' Front ................................ Rear ............................ Depth .... Height ............. Number of Stones ............................................................................... 9 Size of lot Front... /.~-.O / Rear ..... /~.Z2..~. .................. Depth ..../.~...'~.~. ............ 10 Dote of Purchase .............. ~ ........................ Nome of Former Owner ......... ~ ........................................ 11. Zone or use d~str,ct m which premises are s~tuoted ........... "~i(.../~ .................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulation ......... .~...¢~. ................................... 13. Wdl lot be regraded ......................... W, II excess fill be removed from premises: ( ) Yes ~ No 14 Nome of Owner of premises .............................................. Address ................................ Phone No ...................... Name of Architect ............................. Address ................................ Phone No ...................... Norne of Contractor ..................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly alF'buddmgs, whether ex=sting or proposed, and red,cate all set-bock dimensions fror propcrty hnes Gwe street and block number or descnphon according to deed, and show street names and indicat whether interior or corner lot STATE OF NEW YORK, ~ ...................... ~SS rE'Z/ COUNTY 0~c-~FI4¢-,4~ ' ~3. '~o~c~ .......................................................................... being duiV sworn, deposes and says that he ~s the opphca, (Name of ind~wduol s~gning contract) above named He ,s the ...................... ~.....c~......x~..?--:..~... ................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sad work and to make and f~ th~s apphcot~an, that all stctements contained m th~s apphcahon are true to the best of his knowledge and behef; ar thor the work wilt be performed ~n the manner set forth m the opphcahon filed therewith Sworn to before me this _~ .............. · ;~.~. (:]ay ol' .... ~.,, ,.;~ ...... Notory P~.,r~c, _..~ ................ ~ ............................ /-#rARY E DAWSON NOTARY"PUBLIC, State ol New York t~, ~2-4643721, Suffolk Cou~,y~, TII111 Expires March 30, 19 ~___.; County ............. ~.,...~:...~..; ~ .......................... (Signature of opphcont) -Z /5'0 0 k "/E~,~ o~' ~.vcrr~.'o~