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Home My WebLink About9330-zNO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy , No....Z9~9.8 .... Date ...J.a.n.u..a.~....~9 ........... ,19.7..9.. THIS CERTIFIES that the building located at .~...C.e.d..ay..P, qi.n~..D..r: ...... Map No... 90 ....... Block No .......... Lot No ........ '[50 ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...J.u_~..e.. ? .......... , 19..7.7. pursuant to which Builamg Permit No...9~..0.Z dated ...Jv_~.e...23 ........... , 19.7.7.., was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... P.r~¥ .at.e..Q .n.c..F..a.~..i.~y...~..e.~.~.±n5 ............................. The certificate is issued to ........ q~.n.n...F....H. 9.~.d~.m..m~.. ......................... (owner, ( ' _) of the aforesaid building. Suffolk County Department of Health Approval .. Januamy..~6..,...19.7.9 . 7.-.SO.-7s...*. Robert A. Villa UNDERWRITERS CERTIFICATE No. N~151~6. ............. HOUSE NUMBER .... 5 ...... Street ........ Ced~m..Po~q~. DR.. ................ Southold, N.Y. B ' 'n Inspector Cotmty Tax Number 1000-90-2-23 * ~fELL WATER HAS MET ~[ITH THE NEW YORK STATE STANDARDS BUT IS MARGINAL FOR CHLORIDES AND SODIUM. FORM NO. ~- TOWN OF SOUTHOLD 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? 9330 Z Permission is hereby granted to: ...o..t..,e.?......z.~ '.,~...~ ......................... at premises located at ............................................. .q~... ~ ....~...e.a~ ..~'~ ................... ~ ........... ~ ............................... --' pu~uant to application dated ............................. Z~...~ ............. , 1~..., and approv~ Buildjpg Inspector. Fee $ J~J~. ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions AD 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 all buildings, prope~y 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 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 peoperty showing all property lines, streets, buildings and unusua~ 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-exmting dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date.,, .~..1~, .~.. ! ,~,., ,~ ~ ).~, ..... New Budding ..... ~..'~. .....Old or Pre-existing Budding ............ ~acant Land ............. Location of Property ..~..~.~.~. ~, .?~;:~ .~.'~...~.~-,i~. ,-----~. ........... .~.~..~.'~..~.~.~.~... ~ ..... .~...~.'. ..... House No. Street [ Hamlet Owner or Owners of Property ...~...~,.~. ~ .~-~...~... ~ ~ ~,~:~', .~...~.'~:3...~,~. ......................... County Tax Map No. 1000 Section .... ..~(~ ....... Block I Lot ~ ~:~(::) Subdivision ................................. Map No....~..(~. ........ Lot No...~.~.(~. ........ Permit No ........... Date of Permit .......... Applicant..~.~ ~ i~.~'. ~.~..~..~, .~-)..~...~.~..!~, ..... Health Dept. Approval ........................ labor Dept. Approval '1 ....................... Underwriters Approval ........................ Planning Board Approvalt~ ...................... Request for Temporary Certificate ..................... Final Certificate '. ...................... Fee Submitted $ ............................. I Construction on above described building and pe_rml~m_eets all applicable co,es and regulations. TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~....~....~....., 19....?/ ~Application No. Z..'~...2....(~.. ......... --roved /~/ c( c) ~ 19 ~ Permit No~.. ~ ~ 0 ~ ,?~,~/~- D~'p-,-pprove~': ...................................... ' ........................................ ..... ,..~.~....~.. ~ ....................... ........... APPLICATION FOR BUILD NG PERMIT Date ..... ...... ....... . INSTRUCTIONS a. This application must be completely f,lled 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 on premises, relationship to ,Qdjoining premises ar 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 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 applicant Such perm 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 whc~ever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 i admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........ ..... ........... (Address of applicant) State whether applicant is ow,net, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde .................................... .............................................................................................................. Name of owner of premises ...... ..~'~.~.~.~ ............................................. If appJ&c~ i~,.~ corporate, sig,pot.ure ~of duly au~orJzed officer. -7~ -,~ ~ / O (Name and t:tle of corporate officer) Builder's License No .... .~...~ ........................................ Plumber's License No...~...~..~.~.~....~.~...~,~..~.~. ..... Other Trade's License No ............................................... ..Cj..O.i .~.~...~.%, Location of land on which proposed work will be dane., Map No.;~: ...... ! .................. Lot No .......... Street and Number ....... ,,~.~-,.~.,~.,~.....~,~_~..~,.~,,~..~.......~,~---,.%,.,~..~~ -- -- -- ~ Municipali~ State exmhng use and occupancy of premises and intended use and occupancy of proposed construction' a ~,s,tmg use and occup ncy ........ ~,~.~.~.~ ........... ~'~'~'" 7'(' ................................................. b. Intended use and ~cupancy ............................................................................................................................. 3. Nature of work (check which apphcable) New Building %'"'""- Addition Alteration " ~ Repair ................. Removal ................ Demoht~or. ............. Other Work ............................................... (Description) 4 Estimated Cost ........ .¥~...~.',(~..C~..(~. ................ Fee .... ~.~...Z.~.~... (to be pa~d on filing th~s application) I 5. If dwelling, number of dwelhng umts ...................... I .Number of dwelling umts on each floor ........................ If garage, number of cars ..................... ~.~ ~..F ...................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each Wpe of use ......................... D~mensions of same structure with alterations or addmons: Front ................................... Rear ................... Depth ................................ Height .......................... Number of Stones ............................... 8 D~mensions of entire new construction Front ........................... Rear ............................ Depth .................... Height ................... Numb? of Stones ..................................... : ....................................... ¢...~.....~ ........... Size of lot Front ............. .......................... Rear .........~..~..~ ............. Depth .. ~ 9.10 Da~e of Purchase .... ~...../.. ~ ..... ~.. ~.~ ....... Name of Former Owner ...~.~.~~.' ......... ......... 11 Zone or use d~str~ct in which premises are s~tuated ............................................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation' . ...... ~ ................................... 13. Will lot be regraded ...~..~.~ ...... Will excess f,II be removed from prem,ses: ( ) Yes ( ~ 14 Name of Owner of prem~ses ..~.~.~.~.~ Address ................................ Phone No ..................... Nome of Arch,tect .... ~.~.~.~. ~ ...... Address ................................ Phone No ..................... Na,~e~ of Contractor..~X~.~ ~.~ .~.~ Address ................................ Phone No.~.~.Z.~ PLOT DIAG~M Locate clearly and d~stmctly all buildings, whether ex~st~ng or proposed, and red,cate all set-~ck d~mensions fro~ prope~y hnes Gwe street and block number or description according to deed, and show street names and indicai whether interior or corner lot S'I-ATE OF NEW YORi(, /S COUNTY OF .............................. f S ........................................................................................ being duly sworn, dep?ses and says that he ~s the apphcc (Name of ind~wdual signing contract) above named. He ~s the .................................................................................................... , ....................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to oerform or have performed the said work and to make and apphcat~on are true to thejbest of h~s knowledge and belief; this apphcat~on; that all statements contained in th~s that the work w~ll be performed in the manner set forth in the apphcation filed the[rewith. Sworn to before me this ....................... day of ................................... , 19 Notary Pubhc, County (Smgnature of apphcant) OWNm'R: J ouT".,-/o/_,z:;, ,,v. "4. SUFF CO. HI~L'r~ I~l~r, AMI=~OVAL /,W ~ p, o.¢' /-0'7" R'OD£R'ICK VAN ~YC P. C. Lt= ~ND SURVEYOR~GREEN~RT, N. Y. aCAI..E: d'O' = /" JNAUTHORIZED ALTERATION OR ADDITION 'O THIS SUPVEY IS A VIOLATION O~c iECTION 7209 OF THE NEW YORK STATE !DUCATION LAW :OPES OF THIS SURVEY MAP NOT BEARING }IS LAND SURVEYOR'S IN!~:D SEAL OR iMBOSSED SEAL SHALL NOT I~E CONSIDERED ~O BE A VALID TkUE COPY .~UARANTEES INDICATED H.~p.'ON SHALL RUN DNLY TO THE ~EKSON FOP W;JOM THE SURVEY S PREPARED, AND ON HIS B[HALF lO THE .,.~,:..~ I SU 'F' CO' D EPT' OF 'HEALTH SERVICII~ i ' ~A~E~ OF IN~NT , APPROVe= ..... OWNI~R: HEALTH DEPT. APPROVAL ! H. $ 190', -- ~DERtCK VAN ~Y~ P C. LIC. ~ND SURV~OR~REEN~. N.Y. SCALE: +["0 ~ ~ /" fO THIS SURVEY IS A VIOLATION OF SECTION 7269 OF THE NEW YCRK STAI~ EDUCATION LAW COPIES OF TI'IS SURV[Y &~AP NOT BEARING SUFF. CO. D£Frl'*. OF HEALTH $1rRVIGi~ I 51"A"rL~£NT OF I~N I FOR A~ROVAL OF CONS~U~ON ONLY TH,E WAT~ SUPPLY AND Ol~g SYSTEMS FOR THI DBCE WILL ~F~M STANDARDS OF ~UFFOLK CC OF; H~LTH. SERVI~S. APPROVED: ..... Ri[SI. D£PT State standards but zs ma~rgznal for chlorides and sodium. ' ,j ¸ , ,u//oil co. .,v¢, o~ ~H~s su~v[v ~p ~T BEARI~ ~IO~JJD S~AL SHALL N?t ~[ CONSIDER[D VALID T O~ ~ W [~AMP · OF HEALTH ~,,~RVICiE~ , ~A~M~T OF I~ENT FOR APPROVAL OF OONS~UC~ ONLY ~E WAT~ SUPPLY AND SEWAGI DATE: DISP~L SY~EMS FOR THIS RESI O~CR WILL C~F~M TO ~l STANDARDS OF SUFFOhK CO. ,OEP] OF, H~LTH. BERVICES, A~ROV~: ,r ,