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Home My WebLink About9112-zNO. 4 TOWN OF $OUTHOLD BIJ~.BING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupency No. ~ Z~3~ Date ~'E~'7 ~ 197..~' THIS CERTIFIES that the building located at l .~. ! ~..~.~... ~[... Street MapNo. 5~7~ ~ BlockNo. ~ .LotNo. ~ conforms substantially to the Application for Building Permit heretofore fried in this office dated /~A ~CH ~, 19 ./ ?. .---- pursuant to which Building Permit No. / t~A~m 25, 19~.~. was issued, and conforms to all of the req-J~e- dated ........................ , ments of the applicable provisions of the law. The occupancy for which this certificate is issued is /~ 7~UA-7~ ~/~' FA ~/z. y The certificate is issued to (owner, of the aforesaid building. Suffolk County Department of Health Approval/?~..7...~/.,. U~DERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER / 71 ~ Street ~-~~'- AA Building Impeetor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9112 Z Permission is hereby granted..~..~i..~~....~~. '~t°: ~f-_.~-'Z..~ .5 ~ ' .............. ~~.~..~.~.,.~ ............. ,o ~~. ~~~~~. ~ ' .~~ ........... premises ............................ / .................... . ............ .~-: ..................................... ~. .................................................. ..... ~.:.~:'. ........ ~,.~....~:~...: ....... ~~...~ ........................ pursuant to application doted ......... ~...Z.2~ .......... , ]¢.;~.~ond approved by the Building Inspector. Fee ,.Z.~ ..... I~Jding Inspector FOlt~l lqO. 6 TOWN OF $OUTHOLD Bu/Jding Department Town Clerks Office Sou~hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled 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, 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT 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 3erHnent 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ..~......~.... New Building J Old or Pre-existing Building Vacant Land Location Of Property / 7 / 0 ~'/~ / ~ ~'~ /~ ~. ~) ~ ~-- Owner Or ~ners Of Drope.y ~P~ ~ ~/4.~W... ' Su~ivision ~3~ ~ C ~X ' ' & BI ............................................................. LOt No ............. ock No ............. House No ............. o{ ..... ............ r ' rr ' ............ r ....... ~' ................. ~uuor uep[. ~pproval ............... Underwriters A~roval ~)~ ~'~ Pon n ~ ] -- ~' ~ .............................................. n ~ ~ooro ~pp ............. , ............................... R~quest For Tempor~ Ce~fflc~te ........................................ Final C~ificoto Fo* Submitted $ ......... ~ ....... Construction on above described building and permit meets oil apDlicable ccj~Jes and regulations. Applicant ........................................................ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) 7-. 723? ': ' : W' ¥ORk'BoARDiiOF ~RE ' DERwRiTERs ~ ~,~ THE NE ,:. 1 UN ~ ~ '* J~ ~ ~-- ' r~- '--''~' 'BUREAU OF=:ELECTRICITY ~ ' ' ' only t~ electrlcal d~ulpmenr ~ ~scrlbed below a~d introduce~-~ t~e appllcan~named ~n th~ ~q2~qt~t~,~ ' ': J a:M Bare, e/side'Brfd~e, Lane,~aPP. ~300 ~0 Ma~n ~ Cutchogue, L.I .... ...... ' '" ' side 'Section ~,~ ~o/o,o~.~o~t~o.;;: '~ ~ ~, ~,.~i': ~ ~t rt' ~ ~a et out a,,~ao Au~U "%977 : '" ' ' .k: !2 :*Future[aPpliance feeder/s': :1,-~#8, :!-2#!~. : ,,: ,, *',,.~:: ,-,Center,Morich I ~ L Th~s ¢ed*f~cate must not be ~ltered ~n dhy ~nner; return to'the'office-of the Board ff ;ncorrect. qnspectors may be ~r~dehtiols. TOWN OF $OUTHOLD .~ ~/~ BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICB ~ / Disapproved a/c ............................................................................................ ....................... ............... ...................................................... ....... I .................. ~ , ~ ' (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 or areas, and giving a detailed description of layout ofproperty must be drawn on the ditrgram which is part of this application. 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 Building Permit to the applicant. Such permit 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 th~e~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app icable Lows, Ordnances or~' Ragu arians, for the construct on of bud rigs, addit ons or a terations, or for remova 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. ...................... ................ (Signature of applicant, or name, if a~or~oration) ~ ....... (Address of applicant) (I ? ~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ ........................................................................................................................................... Nome of owner of premises ........ :~.~.~..Z~ZC/...-- '" "' .~:,~ / If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ................................. g .................. E ectrcians L,cense No...~.~.~......~..~g.~.~...~..~.~ Other Trade's License No ............................................... 1. Location of land on which p,r. oposed work will be done. Map No.: .~.~C~.~.~....~.~..... Lot No....~.. ................ Street and Number/.~.~..~/5/.~.~.(~3/-~,.....~'..2 ...... :..~'~..~.~-Z./~/~.~...E~.;(,,.... ....................................................... Municipality 2. State existing use and occuppncy of premises and inCenSed use and occupancy of proposed construction: Intended use and occupa,o/ l...".~/..~.x ......... ~.Z~..~Z~.J.x.x, ....................................... / 3. Nature of work (check which applicable): New Building' .....V...... ...... Addition .................. Alteration ................ Repair .................. Removal .................. Demoiitior ............ ~v ..... Other Work ..................................................... ~';~ '] <:'" ~.j (Description) 4. Estimated Cost ...... .~...,~.).~.~....0. ................................ Fee ....~..,~¢,,,....~... ................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ~ ' . '. ,,.*z. ~' Rear"~...~.~. ........... 8. Dimensions of entire new construction: Front ...... ..~.~ ................... ~.. .................. Depth ............... Height .....~..~,. ........ Number of Stories ............./.....~ ............................................................................................. 9. Size of lot: Front ...................... /,~2,,~. ......................... Rear .......... /,,¢.~. ................... DeDth...~...~..Z..~....~. .......... 10. Date of Purchase ............~..~.Z~. ................................. Name of Former Owner ....b...,/,..,.~.~....~.~" 4¢ -- ............................. 11 Zone or use district in which premises ore situated ............. ~....Z-~'.Z'./~.~.~'....~-r..., 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .... ,~.~.¢~. ............................................ 13. Will rot be regraded . ....... ~.].~ .............. Will excess fill be removed from premises: ( ) Yes ,(z~) No 14. Name of Owner of premises ../~..../¢.~..~.~..,)..~..('...8 .~..~..¢..~.. ............ Address/L,/*¢.~./."~.~¢/~.,~.~..,/.~/~fl~o~n~o. ~..~..~-~.~...~.. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~..~.~¢.~..~/..~.~...~...~.¢.../C.¢...~. ............. Address~.C.Z .~...~.~../~.~..~..J/~'~Phone No.~.~...~Z.~.~...~.. ...... PLOT DIAGRAM Locate clearly and distinctly ell buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot, /_~,¢ ~:=7 ( - .CF' STATE OF NEW Y~R~/~/~/' COUNTY OF~~,4 ...... ~'~' ................................................................................................. being duly sworn, depases ~nd soys that he is the ~pplic~m (Nome of individuol signing contr~cf) ~bove nome& He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to bef~ me this ...... ............ ...................... JUDITH T. TERRY ~ t~ignoture 6~canD Notary Public, State of New York No. 52.034~.963 Suffolk County Commission Expires March 30, THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE D~SPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTM£N1 SUFFOLK COUN'~' DEPARTMENT OF HEALTH SEIVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE ?, ,, .S REF. NO. '7 r~%0 ' APPROVED ...... il -'MONUMENT LOT NUMBERS REFER TO MAP OF'/SMAR ACRES" F/I-ED IN THE OFF/CE OF THE CI_EBK OF SUF'FOLI( COUNTY' ON MAR./$,/gX$ AS FI£ENO.$BF~. NEAREST PUBLIC WATER MAIN -' 5 MILES~ WATER SUPPLY - PI~I VA TE WELL ELEVATIONS ARE SHOWN THUS:I$.I AND ARE REFERENCED 7'0 AN A$SUMEO OATUM. YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W, YOUNG SURVEY FOR: JOSEPH BARE 8 MARY BARE L. OTNO. 2; ISMAR ACRES." ¢ CUTCHOGUE ~rowN o~ SOUTHOI-D SUFFOLK CO., N,Y. 1"--40' ;/ ' THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELO OSSERVATJONS AND OR FROM DATA OBTAINED FROM OTHERS O~F HEALTH SERVICES APPLICANT:_ ADDRESS TEL ..... dUNE F/LE~ iN'rilE OF~CE OF r~E CLE~F i~L~V~T~NS ~eE SWO~N T~USaS.,:ANO A~E ' ' ~' '" L'YOUNG I yOuNG' N.Y.S. LIC. NO. 12a&5 " "iSMAR ~CRES:"- SOUTHOLD. SUFFOLK CO., N.Y. /972'