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Home My WebLink About9346-zNO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific; te Of Occupnncy No. Z. 7..8.8.9. ...... Date ............. Sep.~;... 1.~.., 19..7.? THIS CERTIFIES that the building located at .... l~a. tn. Road ............. Street Map No.. xX ........ Block No..~ ...... Lot No. X~r .... 0r-~ellt.. I~,~, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... June..30., 1977. · pursuant to which Building Permit No. dated ........ J. tme. .30, 1977.., was issued, and conforms to ~]1 of the req,,ire- ments of the applicable provisions of the law. The occupancy for ~vhich this certificate is ! issued is P~ivate one..fa.~tly, ct~tolling..~$th, aqkli, t. lo~. ? .................... The certificate is issued to . Fradert. ck. & ~ry..~cofie;Ld ..... (owner, lessee or tenant) [ of the aforesaid building. Suffolk County Department of Health Approval N.,.R,. .............................. UNDERWRITERS CERTIFICATE No. pelldillg .................................. HOUSE NUMBER ....~ 991 ~... Street . lgail~, l~oad ..... Or. ii a~. ................. FORD[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9346 Z t Permission is hereby granted to: .................... .O~ie~ ............................................. to .... ~tf.l.~l....,,.~...a~.~ ~t~i~,~...(.l~a~;[~ ~...~n...e~'t z.~...~.g....a.'.,r.e..~.3-....~.. Z ........................................ at premises located at ...~IJJ3,,~&~ .................................................................................................. pursuant to ?ppl,cation dated ................................. ~llt..,~....., 19.. ., and approved bY the t~ujlding In~tor. ............................ Buildin~ In~or I~ORM NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office $outhold, N. Y. 11971 AFPMCATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR znk, 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 Underwr,ters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, o certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s,te 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 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 I 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 Date J ............................................... New Building Addition ~ Old or Pre-existing Building ,- Vacant Land . Perm,t No....c~ ........... ....~ate Of Perm,t ...; .~?..~...A, op t Z..C~......~...~... Health Dept. Approval .......... ~..7. .............................. Labor Dept. Approval ................................................ / Underwriters Approval ~ .Planning Board ApprOval Request For Temporary C_~_ertificate ........................................ Find Certific;te ...... ~. ........................ Fee Submitted $ ...~..... ........................... Construction o~ above described building and.~ermit meets all applic?,l~e ~J~ es and regulations. Applicant ..... :....~.~ ..... ~...~~,~ .................................. Sworn to before me this day o, ............ Nota Pub,ic ...... .... cou Examined ,.. ~.>.'~..~.. .......... Approved ............... .~..\ ....... :.~. .......... , FOF, M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Xpplication No. f...~..~.~....~.. .................. APPLICATION FOR BUILDING PERMIT ~ Date ........~....~.~ .......... ,I 9..?...~.. .... INSTRUCTIONS a. Th~s application must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Building 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diag,.am which is part of this application. c. The work covered by this application may not be commenced before issuance qf Building Permit. d Upon approval of this application, the Building Inspector wdl ~ssue 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 Jn whole or in part for any purpose whateger 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and &ther applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a]terations, or for removalI or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, h6using code, and regulations, and tc admit authorized inspectors on premises and in buildings for necessary inspections. i~'i'~'~'~'~'~'l'i/~;~;~:"c~;' 'name, ifa (Addless of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or builder. Name of owner o{ premises .... ~ ......................................... If applican~ is a corporate, signature of duly authorized officer. (Name and title 9f corporate officer) Builder's License No ........ ..~.....~... ................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will ~e d~ne. Map No ................. ~ ................. Lo~t No ......................... Street and Number .... ~......~....~ ............................................ .~...~- Municipality State existing use and occupancy of premises and in.~ended use and occupanc~ of propased construction: a Exisihng use and occupancy'"'"'~J'~"'"';~'~ i'~~"'"" '"'"'~ '~ ~ ........................................................ b Intended use and occupancy '""..-I~.~'~"~xT.....-...T.~...~"'"".''''''' ~ Nature o~ work (check whsch apphcable) New Bu~lrJ~ng ............ Add,hen ....J,'~.......~.~A]teration . Repair ............ Removal ...... Demoht~ar' . ..... el'her Work ........ (Descnphon) 4 Estimated Cost .~...?..?..~...:.~..~.. ..................................Fee ' (to be pa~d on filing th~s appl~cahon) 5 If dwelling, number of dwelhng umts .................. Number of dwelhng umts on each floor .............. If garage, number of cars ................................................................................................. 6 If business, commercial or m~xed occupancy, spec,fy nature and extent of each type of use ..................... 7 D,me~s,ons of ex,st,rig structures, if any' Front ...... ~ .J...! ............. Rear ...~.../...." ................. Depth ..-~..'~....J Height .... ...'~..~...! ......... Number of Stones ...... J......~ ..................................................................................... Dimensions of same structure with alterat,ons or add,tlons: Front ....~/.Z ..................... Rear .../'~'.~... . .-- ~ .... I~ Depth ...~../.. .................. Height ...... .~....~.. ~ Number of Stones .......... ~-. ............... ' '' ....~......~... f..~....~. ~... Depth. 8 D~mensions of enhre new construchon: Front ....... ...~.....~.....~. ............ Rear ........ Height ..... .~....~. ....... Number of Stones ' 9 Size of lot Front ..... ...~'.]...M~..'~.?. .................................. Rear ..... ~'..J..~...}.-...7. ................... Depth ...../'..~/...~.-.~....~.. ......... 10 Date of Purchase ....................................... Nome of Former Owner .................................................. 11 Zone or use d~stnct in which premises are situated ~:~...~ ............................................................ t2 Does proposed construchon wolate any zoning law, ordinance or regulahon. ....~.-.~ ....................................... 13 W~II ~ot be regraded .... ..~.....O.. .............. Will excess fill be removed from premises: ( ) Yes (~) No ^rch tect ............... ........ Address ................................ Phon. ....................... F~cme of Controetor .~.~..~.~t~r:.~ .......... Address ...~...~ ...... Phone No.~.~...7..~....~.,.~./. PLOT DIAGRAM Locate clearly and dlshnctly oil buildings, whether existing or proposed, ~nd indicate all set-back d~mensions fron, r, ropcrh,, hnes Gwe street and block number or descr~phon according to deed, and show street names and red,cate ~vhether ~nter,or or co~ner lot $, NEW ¥OR.I(, OF ...~. ~..,7F.?,.~. .......... rS S .. . 7'~.f.~...~. ...... ?....3..~.~....~'.~..~..../~.. ............................. be,rig duly sworn, deposes and s~ys that he ,s the (Name of md~wdual s~gning contracf) above named I He ,s the .................. ~.L(.~.~ ............................................................................................................... (Contractor, agent, corporate off,car, etc ) I of sa~d owner or owners, and ~s duly authorized to oerform or have performed th~ sa~d work and to make and file th~s apphcat~on, that ail statements contained ~n th~s apphcehon are true to the b~st of h~s knowledge and behef, ~hat the wc~rk will be performed m the manner set fo~h ~n the apphcahon filed therewith. Sworn to before me this I .... ~ .... day of .............. ~.~.~ 77 J ~~J~~~~ co.. ................. ~ ~ FLOYD ~. KINe, J~ ~ (Signature of applicant) Nota~ Public State of New York No. 52-7267800 Suffolk County Term Expires M~rc~~,,~ 1