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Home My WebLink About9337-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ....... ~..d.d.i.~.5..o.~.. ............................... Location of Property ...~.0..0 ............. [q~.$.h..V. 5. ?.w..3.~.: .............. .O.r. '.a_?.~.~. ..... House tVo. Street Hamlet County Tax Map No. 1000 Sect]on . . .~ ...... Block ........ .~ ...... Lot ....~. ............ Subdivision ........ ~c ...................... Filed Map No .... .x....Lot No ...... .x. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .0/.~..28 ............ 19 77. pursuant to which Building rermit No ...... .c) ~.~.~g. .......... dated ..... J~e. 2~ ............... 1977., was issued, and conforras to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition on existing dwelling. The certificate is issued to ........ g_CT,'FrlxT~ .&. WAZ~TER. ~IJ~I~.3;1~¢~]~ ................... (owner,~ of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N366351 Rev. 1/81 Buitdi~g Inspector FORM NO. 2 TOWN O~ SOUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 9337 Z Permission is hereby granted to: ~..~,~., ....... ~/o....~..~..~,~__.~, ............ ,.:.~a~, ........ ' ............ : ......................... to ~..~_..~~..~..J~~..~ ............................................................... at premiss l~ated at .~..~..~.; ....... .~ .......... ': ............................................ t'"': ............. .............. · ~*~--~ ........................... ~, ~=~=-_--: '-'~ ~z~ ................... ~ ..............:'~'"~7~ ............ ...... ;~ ............ : ............. ,;...,~ ........... ,.~; ......... ~ ....... ;.,...,~a~t .....~ ......... 5~,...~ .................... ~.~ ........... p~o~nf tO a~lication doted .............. ; .............. ;.~..~ ........ 19~.., and opp~ged by t e ~ '?- , Buildihg Inspector, { . ? Co FORM NO. 6 TOWN OF SOUTHOLD Buiidlng Department Town Hall Southold,"" ~uz ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG DEPT. TOWN OF SOUTHOLD ll~strMctjon$ Th~s apohcation must be filled in typewriter OR ink, and submitted in duplicate to the Building inspec- tor w~tn the following; for new buildings or new use: 1. Final sun;ey of property with accurate location of all buildings, t~roperty lines, streets, and unusual natur,:[ or tooograohm features 2. Final aooroval of Health Dept. of water supoty and sewerage disposal--(S-9 form or equal}. 3. Aporova[ of electrtca[ mstallatton from Board of Fire Underwriters] 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planmng Board approval of completed site plan requirements where applicable. For existing buddings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses 1. Accurate survey of peoperty showing all property lines, streets, Ibuddings 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 an,/ housing code or safety inspection of buddings or pre.raises, or other pertinent informa- tmn requtred to prepare a certificate. ; 1, Car'~tflcate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelhng or land use $5,00 3. Copy of certificate of occupancy $1.00 Loc=,,on o,' Property .ff..¢ P.~. ~ ,.YZ£ W../5.~.. ..... ¢. ~./~. ~/I .~. .... Z<.....'Z.....~ .//..¢~ z.. Hou~ /Va. Srreer i Hamlet Owner or Owners of Property ,~ .~.4~Z~' .~--'~' A/~V~.._.._~/./-~..~"-t'~. ~. j ./i~.2~.~..~.~.~.~'"~"Z, ....... . ~ ...... Lot ............ Subdiws~on ............................... F~ted Map No ..... ~ ...... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ...................... ~.. Under,vr~ters Approval ........................ Planning Board Approval .................. Request for Temporary~ficate ..................... Final CertifiCate ........ ' ......... de¢cnbed ' u Id nd ~tt mee's 11 a .... Construction on above . u i[ng a perm'- [ a,~ ~bl~oFes an¢ regulations. TO~V'N OF SOU~OLD OFFICE OF BUILDING INSPECTOR ' P.O BO}[ 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 Deep : Permit. No. ~ ~%7'~ss'ued t~W~ ~, a fmnai' znspection nas / / nas In orcer to comk!ete Chzs file, mt is~necessapy that Ce. ~_.m~= of 0zc"pancy be ~sued a .-, e ~te .... ~!~ase fill out the enclosed ~ ~' ~or.~%s) , return same to the above cffic~ wzth a check for $5.00 payable to the Town oF Sou';hold. Please ~nezcate to wBom the Ceptzfzcate of Occupancy is to be nailed, w-~h this off,ce for an inspection date. a~d aPrange - ~ ~ VL:ec Enclosures Thank you for your prompt aztention. Very truly ycurs, Victor bessar~ Admlnis z.r~ tor~ Examined .......~.....~......~.., Approved ................ L! ........... ~, TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ?..~...~.. .............. D~sapproved a/c ....................... Date ........... 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 location of lot and of buildings on premises, relationship to adloining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th,s applicatic 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 will issue a Budding Permit to the applicant. Such pern 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 Occupan 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 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 describrc The apphcant 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. (Signature of applicant, or name, if a corporation) ........ ....... .................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ................... ..................................................................................................................................................... Name of owner of premises ......... ..'~...~ ...... ...~..~..X~..~.-~.~.~. ..... I~.~.C,)....~i..J~ZZ..~...~..~......[ ............................................... If applicant ,s a corporate, signature of duly authorized officer. (Name and t,tle of corporate officer) Builder's License No .... ~.~...~...O..cf.~......~...c.~.,~ ................... Plumber's License No..~./..~.¢.~......~.~...'~..~.~[ .............. Electrician's License No.....~..~...~......~..~.~...~.~......'. ....... Other Trade's License No ............................................... ~'c~i //; ~,~, Location of land on whkch~p~g~,sed,~r~k ?Il nbe done. Map No~~.."'~z~......z. ..... Lot No ..................... Street and Number ~ .~ .',,~¢.....--~;.~;...~ .... ...................... ! ............................. ..... State existing use and occupancy of premises and intended use and occupaicy of proposed construction: a Exisit,ng use and occupancy ........ /.......~....~.~.~../..~....~. ................................. ~ ........................................................ b Intended use and occupancy ..... ..~....~..~...~..~o.....~....~..fl../-~,.~'.?. .......................... ! ........................................................ 4 5. 10 11. 12 13 t4 property lines Gwe street and block number or descnphon accord,n~ whether interior or corner lot Nature of work (check which apphcable) New Building ........... Addition .......'~. ....... Alteration ............. Repmr .................. Removal ................ Demohhor. ............... Other Work ................................................. . .~../. OC~ / ~ o ~_ (Description) Estimated Cost ..~ ........... .Q.. .................................. Fee ................................................................................... (to be pa~d on filing th~s apphcation) If dwelling, number of dwelling units ....... ~ ............ Number of dwelling umts on each floor .... ~.' ................... If garage, number of cars ........... ~. ............................................................................................................ If business, commercial or m~xed occupancy, sp..ec~fy nature and extent of each type of use ........................ Dimensions of exlst,ng structures, ~f any: Front .... .~..¥. ................ Rear ....~....~... ..................... Depth ...~.~. ......... Height .../....~..f.q~..y ....... Number of Stones ........ ./. ............................................................................................ D,mens,ons of same structure with alterat,ons or addlt,ons: Front ...... .~.., .~... .................. Rear ...~..~. .............. Depth ..... .-..~.(~.. ........... Height .../...~..I. ............ Number of Stories ...... (. ................. D,mensions of entire new construct,on Front ........... ,,~.¢.-~, ............... Rear .... ~...C~.. ................ Depth ..../..~. ........... Height ....../..5(t Number of Star,es /. ........ Size of lot Front ....... ...~.....~...o.. .............................. Rear .... _-4..(,~..~. ......................... Depth ....,,~..~..~. ............... Date of Purchase ......... ~ ..~.~.. ................... Name of Former Owner . .~..~..~.....~.o....3~..~..¢'!j?.~. ................... Zone or use d~stnct In which premises are s~tuated ........... ~4,-.~$.~.c.* .<J. '~.~.~/...~. ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........ ..'~..~. ..................................... Will lot be regraded ..... ~..~.6 ............. Will excess fill be removed from premises: ( ) Yes (>g No Name of Owner of prem,ses ...~....~:..~.~..L....r('.~./'?~/..~...~..~.. ............ Address .~.:.~/.~.~.~..d....0..L,.. ............ Phone No ..................... Name of Architect .................................. Address ................................ Phone No ..................... Nome of Contractor .~..~¢'..c)...°..~.~... 0c.~.,5 .. ,: ............. Address ..~..q..9..o.....c?...~...,(~.¥. ..... Phone No..~..2,.~......3~..~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and mdmate all set-back dimensions fro~ names and ind~ca~ COUNTY OF ..~J, cf~/"~C'~r..'~.. ....... fl?'"~ , , .~.....~T... beln dui sworn e o es an sa that e~ th ......................... /.f~ ......~ ..................: ........ g y ,dp ~s d ys h's e applica, (Name/of-[ndivldua[ s~ng contracf) above named. /"'~z/ ~/h f~ ; He ~s the ............................ ~T....~....T~T...~ ................................... r ...................................................... (Contractor, agent, corporate officer, etc ) : of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f, this apphcation, that oil statements contmned ~n this apphcat~on ore true to the best of his knowledge and behef; o, ti,or the work will be perfor, m~d in the manner set forth m the opphcahon filed therewith. Sworn to be~o,~me th,s...~Z~..., day of (,~'X ~ I ~t,,~jj ................. .... ~ ............. , n9~7. !/./~f// Notary~.~.//~~ ~s0~-~Pu~]~'. ............. £ ~ .~~ ........ Cou ty ..................................... (Signaturet ..................................................... of applicant)